Quiz sobre Diabetes Tipo 1 y 2

Diabetes Pharmacology and Pharmacogenetics in Endocrinology and Metabolism

• Diabetes Mellitus (DM) is a chronic metabolic disease characterized by hyperglycemia. Different types exist, including type 1 (DM1), type 2 (DM2), gestational, and Latent Autoimmune Diabetes in Adults (LADA).

Definition and Epidemiology

• DM is a chronic metabolic disorder characterized by high blood sugar. DM1 and DM2 differ in several aspects:

  • Sex and Age of Onset: DM1, often appearing before age 30, affects both genders equally, while DM2 tends to manifest later in life (age 40) with males often affected more frequently.
  • Onset: DM1's onset is usually sudden and abrupt, whereas DM2's onset is typically gradual and often unnoticed.
  • Weight: DM2 is often associated with obesity (80% of cases), while DM1 does not have this significant correlation.
  • Remission: DM1 rarely goes into remission. DM2 might sometimes into remission.
  • Insulin Treatment: DM1 requires lifelong insulin therapy, whereas DM2 typically does not require insulin initially and sometimes insulin is required later.
  • Genetics: DM1 shows a genetic predisposition with identical twin concordance rates between 40-50%. DM2 has a more complex genetic profile, including associations with HLA (human leukocyte antigen) and the potential involvement of chromosome 11.

• Autoimmune response in DM1 presents with a significant presence of autoantibodies (85-90% of cases), and often linked to viral etiology and cellular immune response in the pancreas.

• Prevalence of Diabetes: Globally, approximately 61 million adults are diagnosed with diabetes. A significant number of cases (one in three) remain undiagnosed.

Global Prevalence of Diabetes

• In 2021, roughly 537 million adults globally lived with diabetes.
• A large proportion (3/4ths) of these individuals lived in middle-to-low-income countries.
• Approximately 6.7 million deaths were attributed to diabetes worldwide in 2021.

Risk Categories and Diagnosis

• Different criteria exist for identifying individuals with prediabetes and those at increased risk of developing diabetes.
• These include fasting blood glucose levels, 2-hour post-glucose levels, and HbA1c values. Different organizations and guidelines provide specific thresholds and classifications.

Acute Metabolic Complications (Hyperglycemia)

• Hyperglycemia defined as blood sugar above normal. This can range from mild elevation to severe hyperglycemia (ketoacidosis and hyperosmolar state).
  • Specific treatment for severe hyperglycemia includes administering insulin, hydrating with fluids, and correcting electrolyte imbalances.

Diabetes Management and Treatment

• The treatment plans vary depending on factors like individual patient needs, the type of diabetes and duration, and the presence of other relevant health conditions.

  • Basal insulin: This is a long-acting insulin form (ex: Detemir, Glargine, Degludec) usually administered daily to maintain control when fasting.
  • Prandial insulin: Rapidly and short-acting insulin (regular insulin, Lispro, Aspart). These insulins are taken at meals and help control the blood sugar spikes.
  • Correctional insulin: Rapid acting insulins, administered when the blood sugars are high in addition to the above mentioned insulins depending on the specific patient condition.

• Pharmacologic interventions to control blood sugar include various classes of drugs (e.g., metformin, sulfonylureas, glitazones, DPP-IV inhibitors, and SGLT2 inhibitors).

  • The choice of medications will depend on the patient's individual characteristics and type of diabetes.